Provider Demographics
NPI:1609107713
Name:ALAM, MOHAMMED SHAFIUL (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:SHAFIUL
Last Name:ALAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 S SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5010
Mailing Address - Country:US
Mailing Address - Phone:516-398-0346
Mailing Address - Fax:718-291-4205
Practice Address - Street 1:2544 S SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5010
Practice Address - Country:US
Practice Address - Phone:516-398-0346
Practice Address - Fax:718-291-4205
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist